The impact of an automated dose-dispensing scheme on user compliance, medication understanding, and medication stockpiles

Abstract

Background: It has been assumed that a new health technology, automated dose-dispensing (ADD), would result in benefits for medication users, including increased compliance, enhanced medication understanding, and improved safety. However, it was legislators and health professionals who pinpointed the assumed user benefits. Neither Danish nor international studies dealt with users' perspective on ADD in general or with respect to the pinpointed benefits, and thus exploration was needed.

Objectives: The objective of this article is to respond to the following research question: How does ADD affect users' handling and consumption of medication in terms of compliance behavior, and how does the assumption of user benefits made by health professionals and legislators measure up to users' experiences with ADD?

Methods: The results built on a secondary analysis of 9 qualitative interviews with a varied selection of Danish ADD users. Decontexualizing and recontextualizing provided the framework for data analysis. Compliance behavior was framed by a theory classifying noncompliance as either conscious or unconscious.

Results: Most interviewees were noncompliant in various ways, with conscious noncompliance being the more frequent type of behavior. After switching to ADD, most users experienced no change in understanding of their medications. ADD did not lead to automatic removal of old medications in users' homes; in fact for some users, ADD led to even larger medication stockpiles. Overall, reports from patients do not show evidence of the positive implications of switching to ADD assumed by health professionals and legislators before implementation.

Conclusions: As a technical aid to simplify complex medication regimes, ADD alone does not appear to eliminate noncompliance or provide a better medication understanding, nor does it automatically eliminate stockpiles of old medication in users' homes. The gap between the perspectives of users and health professionals makes a compelling case for considering users' voices in the development and implementation of future health technologies.